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General NPI Number Information
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NPI Number | 1174720437
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Entity Type | Individual
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Provider Name | JAVIER JORGE LASA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 6622 FANNIN ST WEST TOWER, W6006
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City | HOUSTON
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State | TX
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Zip | 77030-2300
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Country | US
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Telephone | 215-531-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-9087
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Country | US
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Telephone | 214-456-2331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | MT186232
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD432001
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD432001
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | Q0097
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | Q0097
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License Number State | TX
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